Admissions Office printable pdf download

Admissions Office

Southeastern Technical College

Name and Address

Admissions Office

3001 East First Street

Change Form

Vidalia, Georgia 30474

Phone: (912) 538-3100 ~ Fax: (912) 538-3156

Website:

ADMISSIONS OFFICE

__________________________

SS#

Currently Enrolled? ( ) Yes ( ) No

Current Name ____________________________________________________

New Name______________________________________________________

)

(As it appears on Social Security Card - Verification Required

Please provide a copy of one of the following legal documents verifying

your name change and a copy of your social security card:

• Marriage License/Certificate

• Divorce Decree

• Court Order

• Adoption Papers

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New Address: ___________________________________________________

City___________________________ State _______________Zip__________

County_________________________________________________________

Telephone Number: _____________________________________________

____________________________________

_________________________

Signature

Date

Admissions Office